HEME 1 Flashcards
Multiple Meyeloma presents with what 4 classic end organ damage?
“CRAB”
Calcium increased
Renal insufficiency
Anemia
Bone pain/lytic lesions.fractures
What do you see in Serum Iron, Ferritin, TIBV and Transferrin Sat (Iron/TIBC) and MCV in…
Iron def anemia?
Thalassemia?
Anemia of chronic disease ?
Iron Def Anemia:
- Low Iron
- Low Ferritin
- High TIBC
- Low Transferrin Sat
- Low MCV
Thalassemia:
- Increased Iron
- Increased Ferritin
- Decreased TIBC
- Very high Transferrin Sat
- Low MCV
Anemia of Chronic Disease
- low Iron
- High Ferritin
- Low TIBC
- Normal to low Transferrin sat
- Normal to low MCV
What is the primary difficulty in cross-matching blooding patients with hx of numerous prior blood transfusions?
Patient develops Alloantibodies (Abs against RBC Antigens)
How do you Dx Sickle Cell Anemia?
Hemoglobin Electrophoresis.
What is the genetics of Glucose-6-phosphate Deficiency?
What groups of people do you typically se G6PD?
X- linked recessive
Asians, African, Middle eastern.
In G6PD, because of a lack of the enzyme that normally protects against oxidative stress, you get hemolysis due to what 4 major triggers (most are meds) ?
During an acute G6PD flair what do labs show?
What are the three classic findings on blood smear?
- Sulfa drugs
- Fava beans
- TMP-SMX
4 Nitrofurantoin
Labs: (hemolytic labs)
- decreased Haptoglobin
- Increased LDH
- Increased indirect Bilirubin and TBili
- Increased Reticulocytes
Blood SMEAR:
- Heinz bodies
- Bite cells
- Schistocytes
How do you DX G6PD?
What do you do during active episodes of hemolysis?
G6PD assay, but can be falsely negative during active hemolytic episodes. So repeat After episode if negative.
Active hemolytic Episodes - remove offending agent. self-resolves in 1-2 weeks.
The differential for normocytic anemia remains broad, But can be categorized under what two etiologies…
In working up the etiology of normocytic anemia what 5 tests do you want to order to determine if the etiology is due to hypo proliferation vs destruction?
- Decreased RBC production (CKD, leukemia)
- RBC destruction (SS, G6PD, PNH, HS)
Initial labs:
- Tbili/direct Bili
- Haptoglobin
- LDH
- Reticulocytes
- Smear
What two diseases have Spherocytes on the smear?
What tests help differentiate the two?
- Autoimmune Hemolytic Anemia:
- Coombs test will be positive - Hereditary Spherocytosis:
- Osmotic Fragility test will be positive
Serum-Ascites Albumin Gradient can help differentiate the etiologies of ascites…
What value of SAAG is the cut and what does it mean?
SAAG < 1.1 - Non portal HTN (peritoneal cancer, Peritoneal TB, Nephrotic syndrome, pancreatitis)
SAAG > 1.1 - Portal HTN (CHF, budd chiari, Cirrhosis)
How long do you treat first time DVT that was provoked?
3-6 months.
IVC filters can be placed for patients with DVT but Anticoagulation is contraindicated, or they develop another DVT while on AC…
What are the two longterm complications of IVC filters?
1) Recurrent DVTs (doesn’t stop them from forming)
2) IVC filter thombosis.
(IVC filters dont affect overall mortality)
For high risk surgeries (regarding DVT), what is the optimum ppx method to prevent POST OP DVT?
In what 2 situations would you not AC?
LMWH (better than warfarin, unfractionated heparin or any other method)
- Plt < 50,000
- Current bleed or recent bleed/ICH
Children under 2 years of age can develop iron deficiency anemia in what 5 situations?
What is the universal anemia screening done for PEDS?
- Lead exposure
- Cows milk < 1 yo
- Exclusively breast fed After 6 months
- Toddlers who consume > 24 ounce of milk/day
- Picky eaters and don’t eat iron rich food (meats and cereal). Ie- eat mostly fruit.
Screening @ 9-12 months
The Mentzer Index = MCV/RBC count.
What Mentzer Index score can be used to differentiate between Iron def anemia and Thalassemia?
MI> 13 –> Iron def anemia
MI < 13 –> Thalassemia
